Welcome!

Please take a moment to familiarize yourself with this form. The information required to complete this form is fairly extensive and may require some additional thought as you answer the questions. As such, you may want to make some notes prior to filling out the questionnaire. Information entered and not submitted will not be saved.

Please fill in the information below as applicable to your business. After completion, please submit using the Send To Programming button at the bottom of the form. If you have your own script and/or protocols already typed, you may send that in addition to this document, but please make sure that you include as much of the information below as possible.

Please tell us your name:

Your Phone Number:

Your email address:

How did you hear about us?

What is your anticipated start date?

Please note: our programmers will assess your setup information once it has been received, then notify you with an estimated completion date.

Company / Practice Name

Is this account for any sort of a Medical Office?

Type of business / practice?

Office Street Address

City

State

Zip

Office Phone:

Unlisted Phone (if applicable):

Fax Number:

Company Email Address (if applicable):

Office Hours:

Are you the manager?

Yes, I am the manager

If not, please let us know the Office/General Manager Name:

Manager Phone:

Manager Email:

Do you handle billing?

Yes, I handle billing.

If not, please let us know the Billing Contact:

Billing Phone:

Billing Email:

Building Your Account

Please help us start building your custom account! We use scripted software, so the answers to these questions can be quite specific and conform to the nature and needs of your business!

What hours of the day do you intend to use our service?

Answer Phrase (How would you like us to answer the phone?):

What information should we collect from a caller for routine matters? (If applicable)

This list is not all inclusive – if you require additional info, please note it below. We can also tailor the questions asked based on the nature of the call, who is calling, etc.

Procedure to follow for routine calls (example: hold for scheduled email or fax; relay as they are taken):

If we are relaying messages by email or fax, what day(s)/time(s) do you want to receive them? (Note: we can send messages to you at different times on different days if needed.)

What information should we collect from a caller for emergency / urgent matters? (If applicable)

This emergency list is not all inclusive – if you require additional info, please note it below. We can also tailor the questions asked based on the nature of the call, who is calling, etc.

Procedure to follow for emergency / urgent calls: If there is a specific protocol to follow, please include those instructions in an additional document. Also include if you would like a recap/record of emergency/urgent calls dispatched on the scheduled fax (if applicable).

Are there any special instructions with regard to what types of messages we should or should not take, and/or dispatch to the person on-call?

Does your office use an On-all schedule?

Yes, we use On-Call

No, we do not use On-Call

We have the ability to program your schedule in advance – OR – we can allow your business to have access to our secure web portal, where you are able to program your own on-call information! Please contact us for additional information.

If you have an on-call schedule (whether it is daily on-call, weekly, etc.), please detail it below and attach a sample at the bottom of this form to allow for appropriate programming in our system.

Please provide any that apply: Staff names & numbers (Home, Cell, etc.), the procedure/order in which to call them, how long to wait between each dispatch attempt, etc.

On-Call staff information and procedures can be attached as a separate list or document below or sent separately.

Please note: We offer an enhanced texting option with delivery/read options that is also secure and HIPAA compliant. It enables our staff to see when/if the message has been read, and escalate if there is no response. Please contact us for additional information.

Staff Names & Numbers

Procedure to follow for 2nd calls (callers that have not received a response to their initial call):

If you are attaching additional information, please do so here prior to hitting the Send To Programming button. Additional documents can be sent via email or by fax to 215-723-9330 as well.

Sign Up Online

Welcome!

Please note: our programmers will assess your setup information once it has been received, then notify you with an estimated completion date.

Building Your Account

Please help us start building your custom account! We use scripted software, so the answers to these questions can be quite specific and conform to the nature and needs of your business!

Please note: We offer an enhanced texting option with delivery/read options that is also secure and HIPAA compliant. It enables our staff to see when/if the message has been read, and escalate if there is no response. Please contact us for additional information.

Please note: complex changes made during the initial setup/programming process could delay the start date and/or incur additional programming fees.

When finished completing form, please click here to submit. Thank you!